Murashima Miho, Kumar Dinesh, Doyle Alden M, Glickman Joel D
Renal Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Hemodial Int. 2010 Jul;14(3):270-7. doi: 10.1111/j.1542-4758.2010.00438.x.
Intradialytic blood pressure (BP) variability may be associated with increased mortality. We examined the effect of short daily hemodialysis (SDHD) on intradialytic BP variability relative to conventional thrice-weekly HD (CHD). This is a retrospective cohort study. Subjects were those converted from CHD to SDHD (n=12). All intradialytic BPs were collected on the last month of CHD, and on month 6 of SDHD. Absolute predialysis BP level and intradialytic BP variability were defined as the intercept and average residual terms, respectively, from a mixed-effects linear regression model of time on BP. Dialysis modality was a predictor variable (CHD vs. SDHD). Outcome variables were intradialytic BP variability and hypotension (BP<90/55 mmHg at any time during HD). In addition to a predictor and outcomes, the demographics, estimated dry weight, and ultrafiltration ratio were examined. The median (range) age of the patients was 48 (34-77); all had hypertension, and 4 (33%) had diabetes. By a mixed effects linear regression model, the intradialytic systolic BP variability was 13.2 (quartile range 9.5-14.0) mmHg and 10.0 (8.3-10.9) mmHg for CHD and SDHD, respectively (P<0.006). Intradialytic diastolic BP variability was also significantly reduced (7.7 [6.4-9.2] vs. 6.1 [5.5-6.6] mmHg, P=0.005). Relative to CHD, less hypotension was observed during treatment on SDHD: the odds ratio (95% confidence interval) was 0.36 (0.16-0.81; P=0.008). In this retrospective study, SDHD was associated with less intradialytic BP variability and with fewer episodes of hypotension during treatments. Further studies are necessary to generalize these findings.
透析期间的血压（BP）变异性可能与死亡率增加有关。我们研究了每日短时血液透析（SDHD）相对于传统的每周三次血液透析（CHD）对透析期间血压变异性的影响。这是一项回顾性队列研究。研究对象是从CHD转换为SDHD的患者（n = 12）。所有透析期间的血压数据均在CHD的最后一个月以及SDHD的第6个月收集。绝对透析前血压水平和透析期间血压变异性分别定义为血压随时间变化的混合效应线性回归模型的截距和平均残差项。透析方式是预测变量（CHD与SDHD）。结果变量是透析期间血压变异性和低血压（HD期间任何时间BP < 90/55 mmHg）。除了预测变量和结果变量外，还检查了人口统计学、估计干体重和超滤率。患者的年龄中位数（范围）为48岁（34 - 77岁）；所有患者均患有高血压，4例（33%）患有糖尿病。通过混合效应线性回归模型，CHD和SDHD的透析期间收缩压变异性分别为13.2（四分位间距9.5 - 14.0）mmHg和10.0（8.3 - 10.9）mmHg（P < 0.006）。透析期间舒张压变异性也显著降低（7.7 [6.4 - 9.2] vs. 6.1 [5.5 - 6] mmHg，P = 0.005）。相对于CHD，在SDHD治疗期间观察到的低血压较少：优势比（95%置信区间）为0.36（0.16 - 0.81；P = 0.008）。在这项回顾性研究中，SDHD与透析期间较少的血压变异性以及治疗期间较少的低血压发作有关。需要进一步研究以推广这些发现。
